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Policy in Plainer English
25 minutes | May 4, 2021
Food and Health Care - Season Finale
We're wrapping up our series on food and health care with a conversation with Georgia Maheras of Bi-State Primary Care Association. If you'd like to browse all the episodes in this series, we've linked them below in order. This season the episodes built on each other more than in our previous series, so we recommend taking it from the top and working your way through: Food & Health - An IntroductionHunger Screening - Part 1Hunger Screening - Part 2Predicting Food InsecurityCare CoordinationCare Navigator Help Me GrowBonus: Panel on Connecting to Food ResourcesFood and TransportationMedically Tailored MealsLifestyle Medicine - Part 1Lifestyle Medicine - Part 2Children & Healthy EatingFood Prescription Pilot Program As mentioned on this episode, Bi-State Primary Care Association recently received a grant to continue work on food in health. Keep an eye on the site VTFoodInHealth.Net for more details.This season was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $99,960 with 0 percentage financed with non governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government. (The podcast was a very small percent of the award).
19 minutes | Apr 19, 2021
Food Prescription Program
In our final example of a food in health care project, we welcome guests Chelsey Canavan and Natalie Romano from Dartmouth-Hitchcock and Jennifer Fontaine from the Upper Valley Haven to discuss a new Food Prescription pilot.You may have also heard of Produce Prescriptions, which are a way for health care practices to help patients increase their fruit and vegetable consumption. Produce Prescriptions have a variety of sources for support, including from the USDA, and you can read examples of different forms these programs take here. This Food Prescription project includes plenty of produce, but provides a more full diet with whole grains, dairy, and lean protein as well.One thing mentioned in this episode is waivers and forms that allow organizations to share patient information. The Harvard Center for Health Law and Policy Innovation published a guide in 2020 on navigating HIPAA in food and health care partnerships. Also, here is the article on which I based my comment that we don't produce enough fruits and vegetables to meet basic dietary recommendations.This episode covered a lot of territory and pulled together many themes from the season. Join us next episode for the season finale.
19 minutes | Apr 5, 2021
Children and Healthy Eating
This episode we talk with two people leading programs that engage with children around topics in healthy eating: Koi Boynton, from Healthy Roots Collaborative, and Emmy Wollenburg, from RiseVT speaking about Dinner Together. If you're interested in programs designed to help children access healthy food, our earlier episode on Help Me Grow also touched on this topic. In this episode, Koi mentions that Farm-to-School is a long-established approach in Vermont - which is true, we are one of the leading states in the country in farm-to-school programming. To learn more about Farm-to-School resources, check out the Vermont FEED (Food Education Every Day) website.We did not talk a whole lot about the idea of making healthy choices convenient choices, but that, too, is an established approach. For an example of programs designed with the idea of making healthy food choices the default, check these resources from the Vermont Foodbank.
15 minutes | Mar 22, 2021
Lifestyle Medicine - Part 2
You will find important context and links at the first half of this 2-part episode on Lifestyle Medicine, so if you haven't checked that out, there's no time like the present. This episode features a conversation with the Lifestyle Medicine team at Springfield Medical Care Systems - Laura Jensen, Adam Ameele, Scott Durgin. It also mentions RiseVT, which funds part of Laura's position and helped with some elements of starting the SMCS program (which began with a HRSA supplemental grant for FQHCs). Another item mentioned in this episode is what determines the flavors we enjoy. Did you know I wrote a book on that? Seriously, I did, that's not a joke. I'm not saying it sold well or that it's still in print, I'm just saying I wrote one - go ahead and message me if you want a copy. OR you could read a book on this topic that sold quite well, Bee Wilson's First Bite.
16 minutes | Mar 14, 2021
Lifestyle Medicine - Part 1
In the first of two episodes on Lifestyle Medicine, we interview Dr. Elisabeth Fontaine and Dr. Scott Durgin. They provide background on the Lifestyle Medicine framework, which will set us up to talk to more members of the Lifestyle Medicine team at Springfield Medical Care Systems about how they're implementing support of a plant-based, whole food centered diet with their patients. That's Part 2 and it will be great, so be prepared by listening to this one first.Links mentioned in this episode include:American College of Lifestyle Medicine - Which includes the diagram of the six areas of focus.While you can find resources at the general link above, Dr. Fontaine also recommends The Plantrician Project, Lifestyle Medicine Economic Research Consortium, Nutritional Update for Physicians: Plant-Based Diets, The Power of Plants.We also referenced Michael Pollan's In Defense of Food. The two websites for Dr. Fontaine's current work: Let's Lead and Plant Based Telehealth.If you want the details on those primary care spending percentages cited in the show, rest assured we had a work group on that. Here is the report (Feb, 2020). Ready for Part 2 of this episode? It's posted here.
17 minutes | Feb 24, 2021
Medically Tailored Meals
This episode we welcome David Waters, CEO of Community Servings, to our show. Community Servings is a Massachusetts-based Medically Tailored Meals (MTM) program that is also a leader in the national Food is Medicine Coalition. Community Servings was founded in 1990 to serve local Dorchester and Roxbury residents struggling with HIV / AIDS. It is now a regional organization serving 15 different meal plans to 2,300 patients at a time. You may have heard them mentioned in previous discussions not only for their role in MTMs, but also the Massachusetts State Food Plan. You can access that plan from the Food is Medicine Massachusetts coalition. As referenced in this episode, there are a lot of resources out there on Medically Tailored Meals. Here are some highlights:Definition of "Medically Tailored Meals" and guidelines.FiMC Accelerator Program - a 12 month intensive program for creating and scaling new MTM projects.Research on MTM impacts - examples from the FiMC research library, note that many programs are also doing intensive program evaluations with partners (for example, insurance payers) that aren't necessarily published. This may merit another episode for the data lovers in the crowd.California Food is Medicine Coalition - Notable among the different MTM programs because California has a lot of projects going within a single state and they are working together to develop funding models and study impact. Examples of Nutrition Information - God's Love We Deliver, the NYC-based MTM program, has some great nutrition resources and fact sheets that show how they tailor meals for different medical conditions and food preferences. Where to find out about MTM work in Vermont - part of Bi-State's current Food in Health Care grant involves a consultant-led planning process to develop next steps for exploring MTMs in Vermont, look at this page for background information and look for new updates in late spring, 2021 when the project will be wrapping up its first stage.Special thanks to Marydale DeBor of Fresh Advantage LLC who is working with Bi-State on our MTM project and helped arrange this interview.
18 minutes | Jan 11, 2021
Bonus Episode: The Future of Audio-Only Health Services
The Policy in Plainer English podcast had been taking a break between seasons, but we return now briefly to bring you this bonus episode on the future of using the telephone in health care. It is a summary of the report from the working group on audio-only telemedicine reimbursement in Vermont. But also we tell you the future of telehealth.Because we dream big in health care policy in Vermont. If you would like access to the original report, with details and a reliable narrator (aka the Department of Financial Regulation), you can find it online here. This would also be a good opportunity to go back and review Season 2 of Policy in Plainer English, which was devoted to telehealth during COVID-19. You can find all the episodes linked from the Season Finale here. You can also review the Telehealth in Vermont Resource Guide for many, many links to learn more. Also, a tip from the audio editing, I did not slow down my natural speech patterns on this one - this is how fast I talk. I had 6 months of difficult work and 114 pages of final report to get through in approximately 15 minutes of podcast, that's a lot! If you don't like the information reviewed this quickly, your podcast player should have an option to play back more slowly.
15 minutes | Dec 17, 2020
Food and Transportation
Not to be confused with our episode on Telehealth and Transportation, this episode is on Food and Transportation. . . perhaps we're adding up to a season on transportation. In this episode Faye Mack, of Hunger Free Vermont, and Maureen Boardman, of Little Rivers Health Care, join us to talk about how to tackle the related problems of barriers to transportation and barriers to food access.We mention a few additional tools and examples in the episode:Farm-to-Plate: Local Planning for Food AccessFarm-to-Plate: Resources for RetailersGeisinger Fresh Food Farmacy Presentation - From Bi-State's 2019 Clinical Quality SymposiumAnd with that, we're taking an end of year break - look for new episodes in January!
42 minutes | Dec 7, 2020
Bonus Episode: Panel on Connecting to Food Resources
On November 19th, Bi-State Primary Care Association hosted a discussion with a large panel of organizations that help health care practices and their patients (and others, but we're health care focused) connect with food resources. They discussed how they have adjusted their programs in response to COVID-19. Much as the amount of audio to be edited for this episode exceeded my patience, so too did the amount of text for linking resources exceed the word limit on this podcast posting platform. You can access the full show notes at VTFoodInHealth.net.
18 minutes | Dec 3, 2020
Help Me Grow
This episode features Janet Kilburn and Elizabeth Gilman discussing Help Me Grow, and the role this program's coordinative services play in helping families with young children connect to food resources.As noted in the podcast, connecting for food access is just one piece of what Help Me Grow does and if you want to learn more about all their programs please visit their website: helpmegrowvt.org. You may also want to explore a bit at Vermont 2-1-1, which is mentioned in the episode. This episode builds from the ones that went before it, and in particular our earlier episode on care coordination at health care practices. If you haven't listened to that episode yet, maybe start there and then tune in here.
18 minutes | Nov 22, 2020
We continue our discussion of care coordination with Jodi Frei, of OneCare Vermont, and Patrick Clark, of Gifford Medical Center, and take a deep dive on a particular platform: Care Navigator. Care Navigator is part of a larger approach to Care Coordination at OneCare, and there's a lot of information if you want to learn more about it. The patient programs section of the OneCare website provides an overview of their care coordination work, including a chart showing what constitutes high / very high risk medically complex patients.The 2019 Annual Report explains how care coordination fits into the overall OneCare goals and provides some data on how it is working in Vermont. And, of course, there's always this podcast's Season One: Welcome to Payment Reform if you want to learn more about the overall ACO model (not specific to OneCare Vermont). If you listen to this episode and come away wondering "what are the legal obligations around HIPAA and patient privacy related to online platforms for sharing health information?" then may we suggest a recent National Consortium of Telehealth Resource Centers webinar on this topic? This webinar is part of a telehealth series, but it's illuminating and will renew your appreciation for the complexities of building workable tech tools in health care. If you want to join the line of people who have stepped forward to inform me that 10 is an arbitrary number of people to play backyard football and that a real football match requires 11 on a side, then fine - this is why Patrick didn't want to say sport analogies on tape. As a former rugby player, I feel that the ideal number of players to field on a team is 15.
14 minutes | Nov 9, 2020
The last several episodes went over the process of screening for food insecurity among patients at a health care practice. This episode gets into what happens next - and what happens next usually involves a care coordinator (or similar position). We have Kaylana Blindow (Bi-State Primary Care Association) and Laurie Somers (Northern Counties Health Care) guiding us through this episode.
6 minutes | Nov 2, 2020
Predicting Food Insecurity
Before moving on to Care Coordination as part of our series on accessing food resources, we're pausing for a quick look at using predictive analytics to assess which patients might be at risk of food insecurity and how to best reach them with resources they can use. This episode references several resources on this topic for learning more, so go check these out:The Weitzman Institute webinar series on using technology to address social determinants of health. The entire series is here. The two sessions referenced in this episode were an Introduction to Predictive Analytics and the panel on Food Insecurity.At least one of the Weitzman Predictive Analytics panel organizations has its own podcast, The Carrot Schtick.I referenced the famous pasta story, told here by Malcolm Gladwell for TED. In this telling it's a parable about happiness. And if you believe that happiness is understanding market segmentation then he is right. Also, I told a very simplified version of my graduate thesis - I feel that to defend the honor of my department chair (who may very well be listening) I should add that I did have a more useful theory I was testing. My theory was that traditional customer surveys were over-weighting the opinions of activist consumers, people who felt very strongly that local foods (for example) were important to serve. I came up with this theory while being an activist consumer trying to manipulate surveys. But you could redesign surveys to better pull out the preferences of consumers who, yes, would prefer to eat local foods, but that had other priorities they weren't going to sacrifice along the way. That would allow for offering menu options with broader appeal and pulling products like local foods further into the mainstream. This, by the way, tells you how long ago I was in grad school because at the time eating local was still considered a bit fringe. The most interesting thing I learned from that experiment? When you redesign customer surveys so that activist students can't game the system, many of them get into a huff, refuse to complete the survey, and send you nasty emails. And in case you're wondering why the local vegetarian option in that example was so expensive, it's not just that the ingredients were pricey - building an organic local vegetarian entree meant a lot of hand processing of whole ingredients in a kitchen where that was not the norm for other dishes, which utilized pre-sliced, pre-cubed, and otherwise lightly processed ingredients from national suppliers. This time cost will become important in other episodes, so go ahead and keep it in mind.
17 minutes | Oct 19, 2020
Hunger Screening - Part Two
The second half our of episode on screening for hunger and food insecurity. . . and you can probably guess what these show notes are going to say: start with the first half! In this episode, our original guests (Kristen Bigelow-Talbert and Katy Davis) are joined by Christina Quinlan from Islands Community Medical Services, Inc. in Maine. The subtitle of this episode may be "in which Helen learns that three guest interviews is one guest too many for amateur podcasting." On the plus side, there's a lot of good information here about implementing hunger screening. Maybe be prepared to take notes. . .and definitely peruse what was covered in the first half of this two-parter before diving into the action-packed second half. Looking for more on screening? Check out our episode on Help Me Grow for programs involving educators and child care providers in food insecurity screening and our background one-pager on the evolution of the most common screening tools.
14 minutes | Oct 12, 2020
Hunger Screening - Part One
Kristen Bigelow-Talbert, from Bi-State Primary Care Association, and Katy Davis, from Hunger Free Vermont, discuss screening for hunger and food insecurity. If poor diet leads to poor health, and health care providers want their patients to stay well, then it makes sense that we would screen for poor diet just like we screen for high blood pressure, cholesterol, BMI, etc. - simple, right? Clearly not simple or we wouldn't be podcasting about it. This episode provides background on the interest in screening for hunger / other social factors in our overall health, and some considerations for selecting screening tools. The second installment (linked here) looks at implementation, including lessons we might learn from trying new models during COVID-19. Some references from this episode:Community Health Needs Assessments - Definitely helpful as a prelude to this episode, in fact if you have a moment, start here.EHRs - This will be more important in Part 2, but you might as well get ahead.Hunger Vital Sign - One thing that didn't make it into the finished episode was Katy praising Children's HealthWatch on their work with this screening tool. Children's HealthWatch has a lot of excellent resources.PRAPARE - Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences. The Community Health Centers screening tool. SBINS from Blueprint for Health - Screening, Brief Intervention, and Navigation to Services (acronym or to-do list? This sent me down a rabbit hole of looking up the precise definition of 'mnemonic' and I'm no closer to knowing what to call SBINS)Examples of other screening tools can be found in this toolkit from the Rural Health Information Hub. Confused by the number of different tools? Here's a backgrounder on how they fit together.This season of the Policy in Plainer English podcast is made possible through a grant from the Federal Office of Rural Health Policy to plan for a rural health network that increases communication around the intersection of food and health care in Vermont.
7 minutes | Oct 5, 2020
Food and Health - An Introduction
This episode gives a short introduction to our topic for Season Three. If you want more background information on food access in general here are some good starting places:Feeding America - includes Hunger and Health exploring health connections and the Map the Gap site for statisticsFood Research and Action Center USDA Food Security - includes definitions of commonly used terms like "food insecurity"Food is Medicine Coalition - this is for a very specific area of food work, but it's useful to know as an example of food prescribed to treat particular diseasesNFACT - A UVM led project that uses survey data to capture food insecurity and concerns during COVID-19 response, including stay at home ordersAnd a few other items of interest referenced in the episode:If We All Ate Enough Fruit and Vegetables, There'd Be Big Shortages - NPR, 2019The Great Nutrient Collapse - Politico, 2017Behind Belle Gibson's Cancer Con - The Guardian, 2017 - I keep reading these stories because what I really want to know is, are the recipes any good? They didn't cure cancer, but how did they taste? It's not easy to write a cookbook you know. Columbia and the Problem of Dr. Oz - The New Yorker, 2015One topic we won't cover, but one where Vermont is particularly awesome, is food literally in health care - what food we serve at our hospitals. There's a whole movement around that (Healthy Food in Health Care) and a Vermont network. "Healthy" food in this context includes environmental health along with nutrition. It's a great set of initiatives, but beyond the scope of this series, so we're mentioning it now and for more details you'll have to follow the links above to learn more. This season of the Policy in Plainer English podcast is made possible through a grant from the Federal Office of Rural Health Policy to plan for a rural health network that increases communication around the intersection of food and health care in Vermont.
9 minutes | Sep 21, 2020
VPQHC Connectivity Program
Update: The program described in this podcast is now live and accepting applications from Vermont practices until Oct 5: www.vpqhc.org/ccptelehealthvtIn a follow up to our telehealth series from this spring, we check in with Hillary Wolfley, Associate Director at the Vermont Program for Quality in Health Care on a new program designed to help patients cross the digital divide and access telehealth.Some additional links referenced in this episode:Our earlier episode on Broadband for Telehealth (May 14, 2020).Bi-State's Vermont Telehealth Resources Guide, which we update regularly. Recordings of (most of) the VPQHC telehealth office hours. At the beginning of the public health emergency the rules were changing so quickly that we didn't want to record and post things that were no longer true (that was also the time when we were not just date stamping the resource guide, we were hour stamping it). Hillary references Telehealth Access for Seniors as a program VPQHC is working with, you might recognize some of their materials from the Telehealth Resources Guide in the section on patient communications.
1 minutes | Sep 17, 2020
Introducing Season Three - Food Access and Health Care
We're leaving telehealth and entering the world of food . . . food and health care (although, as former director of a restaurant and farmer association, I'm happy to talk about any element of food that might be of interest). Before we completely exit the telehealth realm, I'm doing a few more quick updates and also reminding everyone that Bi-State Primary Care Association does track telehealth developments in a non-podcast format. Just hop over to our telehealth resource guide for all the updates and details you might ever want.https://televermont.atavist.com/telehealth-in-vermont
30 minutes | Jun 28, 2020
Telehealth in the Time of COVID-19 - Season Finale
We're wrapping up our special series on telehealth with a conversation with Georgia Maheras of Bi-State Primary Care Association, where we hit on some of the highlights of what we discussed over the season.A few items referenced in this conversation that we have not previously linked are: VPQHC Twice-Weekly Telehealth Office Hours, I reference some early data which we discussed in a 2-part webinar series with VPQHC that will be posted here (June 11 & June 18), and we refer to the Milbank study on eConsults. For current federal guidelines, we recommend the Center for Connected Health Policy.About the same time we recorded this episode, the Freakonomics podcast came out with their summary of telehealth and the economics of telehealth. That would be a nice geeky prelude to browsing our full series:Telehealth Special Series - IntroTelemedicine vs. Telehealth (previously recorded)Telehealth Reimbursement & COVID-19 (note that specific rules change frequently, and for the most up to date version check this update page). Telehealth and the TelephoneTelehealth and the Telephone - Chronic Care Management (not everything fit in the first episode)Broadband for TelehealthTelehealth Reimbursement & COVID-19 Part Two (same caveat as above, check our update page if you want specific guidance)TeledentistryTelehealth and Provider ConsultationsTelehealth and Global Budgets (can't get enough of this topic? We recommend our Season One: Welcome to Payment Reform)Transportation and Telehealth Final Episode Bonus: VPQHC Connectivity Care Packages PilotFor more telehealth information, check out our resource guide.
15 minutes | Jun 23, 2020
Transportation and Telehealth
This episode starts where we probably would have started a telehealth series in normal, non-COVID-19 times . . . looking at telehealth as one of the tools available to help overcome transportation-based barriers to accessing health care. Chris Towne, of Northern Counties Health Care*, and Dr. Brian Bates, of Mountain Health Center, join us to discuss this issue.If you want to read more about options for public transit, including the state's plan for connecting patients to medical appointments, the Vermont Agency of Transportation released their Public Transit Policy Plan earlier this year. Slide 9 in this presentation shows travel hours and miles saved in a telehealth pilot at UVMMC. If you want to read more about MAT programs in Vermont and their COVID-19 adjustments, UVMMC has this April 17 blog post. Also, the Rural Health Information Hub has this toolkit on using telehealth as part of MAT programs (in non-COVID-19 times). *Northern Counties Health Care was an original sponsor of this series - and if you feel it's totally unfair that a sponsor got a coveted interview spot then please, by all means, contact us and volunteer to be interviewed to even things out, we would love that.
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